摘要:

Summary:This report provides an updated review of biomechanics and kinematics, clinical results, and technical issues applicable to the posterior cruciate ligament in total knee arthroplasty. The relative advantages and disadvantages of differing designs are presented.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:The most important goals of a total knee arthroplasty are to decrease pain and to improve range of motion and function. Multiple factors are involved in trying to achieve these ends. The use of the continuous passive motion machine in the early flexion mode (70° –100°) and the use of drains, compression dressings, analgesics, and physical therapy contribute significantly to improved range of motion, decreased length of hospital stay, and decreased cost.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Many authors recommend early knee manipulation in stiff total knee arthroplasty. Recurrent loss of motion may occur when manipulation is performed early. The main factors in the development of stiffness are adhesion and scar formation, and delayed manipulation after scar maturation may prevent resultant loss of motion. The authors compared 23 osteoarthritic knees that received postoperative manipulation before 3 months (group 1) with 23 osteoarthritic knees that received postoperative manipulation beyond 3 months (group 2). Demographic data for both groups were similar. The follow up ranged from 2–15 years postoperatively. Preoperative flexion values for groups 1 and 2 were 101.0° and 100.4°, respectively. Premanipulation flexion values for groups 1 and 2 were 64.6° and 64.6°, respectively. Postmanipulation flexion values for groups 1 and 2 were 110.0° and 108.9°, respectively. Final flexion values for groups 1 and 2 were 110.0° and 108.3°, respectively. There was no significant difference for final flexion in the two groups. Thirteen (61%) heterotopic ossification lesions were found in group 1, but three knees (13%) had heterotopic ossification in the premanipulation period; three (13%) Pellegrini-Stieda lesions in the premanipulation period and three (13%) heterotopic ossification lesions in the postmanipulation period were found in group 2.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Obesity is present in a significant percentage of the population, with approximately 97 million overweight adults in the United States alone. Evidence suggests that this percentage is even greater among patients requiring total knee arthroplasty. The possible effects of weight on this procedure have been investigated. Differences in the anatomy, medical history, and pathophysiology have been cited as potential pitfalls when performing surgery on overweight patients. We review how these differences may affect a patient during the preoperative, intraoperative, and perioperative periods and their reported effect on long-term results of the procedure. We think that knowledge of the differences presented by these patients will lead to appropriate modifications in the procedure and patient treatment and may serve to limit the influence of these factors on outcome.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:One of the most catastrophic complications after total joint arthroplasty is a fatal pulmonary embolism. Thromboembolic disease is particularly a problem in lower extremity joint arthroplasty secondary to the development of deep vein thrombosis (DVT) and propagation of the thrombus proximally. The environment created during total knee arthroplasty fulfills the criteria for DVT formation: vessel wall damage, venous stasis, and a hypercoagulable state. There is substantial evidence that suggests the insult and primary event in thrombogenesis occurs intraoperatively. Until recently, however, the main thrust of DVT prophylaxis has concentrated on the postoperative period. A more global approach to patient care during the operative, perioperative, and postoperative periods may result in more effective DVT prophylaxis. An understanding of the pathophysiology and the knowledge of the variety of DVT prophylaxis regimens and their relative efficacy may aid in developing such an approach. This information and the results of recent panel inquiries into the problem of DVT prophylaxis should assist the surgeon in developing a regimen most appropriate for his or her patient population.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Clinical survivorship of primary and revision total knee arthroplasty (TKA) is intimately dependent on component fixation at the time of surgery. Bony deficiency, which is more commonly encountered during revision TKA, can present a problem to surgeons in their effort to produce a mechanically sound construct. This work reviews the classifications and technique-oriented management of the spectrum of bony defects encountered during primary and revision TKA.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Although aseptic failure is relatively uncommon, poor surgical technique and inadequate prosthetic design are responsible for most indications for revision knee surgery. In a failed total knee arthroplasty, it is imperative that the surgeon initially defines the mode of failure of the implant. The most common causes of aseptic failure are loosening, with or without component malalignment, polyethylene wear, ligament instability, extensor mechanism insufficiency, and arthrofibrosis. Failure is discussed under three major headings: patient selection, implant design, and surgical error. The preoperative planning section provides an overview of surgical exposure, implant removal, bone defect classifications, ligament balancing, and wound closure in total knee arthroplasty revision. Surgical techniques in total knee arthroplasty revision are discussed in more depth in part 2.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Total knee arthroplasty (TKA) has proven to be one of the most costeffective procedures that a patient with end-stage knee disease can receive. With improvement in prosthetic design, instrumentation, surgical technique, and rehabilitation, long-term results have been excellent. As a result of the improved functional outcome and an aging population, the number of primary TKAs performed in North America now exceeds the number of primary hip arthroplasties. Concomitant to the increased prevalence of primary TKA, however, there has been a greater need for total knee arthroplasty revision. Although aseptic failure is relatively uncommon, poor surgical technique and inadequate prosthetic design are responsible for most indications for revision knee surgery. In a failed TKA, it is imperative that the surgeon initially defines the mode of failure of the implant. The most common causes of aseptic failure are loosening, with or without component malalignment, polyethylene wear, ligament instability, extensor mechanism insufficiency, and arthrofibrosis. This article highlights tactics in preoperative planning and provides an overview of the rationale behind surgical exposure, implant removal, bone defect appraisal, ligament balancing and augmentation, reimplantation, and wound closure in total knee arthroplasty revision.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID